Besides pain, anxiety and mental “fog,” fibromyalgia patients may also suffer from chronic fatigue symptoms. But natural remedies can go a long way toward restoring lost energy. Here’s an expert guide to what really works for fibromyalgia fatigue...

“When my fibromyalgia flares up, I miss my daughters’ soccer games and dance recitals,” says the 39-year-old Tucson mother of two. “I’m too tired even to sit through a movie with my husband.”

Scott’s exhaustion is typical of fibromyalgia, a condition that causes widespread muscle pain and tenderness, and can often bring about debilitating fatigue.

That’s the result of the body trying to “fight” chronic pain – both physically and mentally, says Jacob Teitelbaum, M.D., author of From Fatigued to Fantastic! (Avery Trade) and a leading expert on both fibromyalgia support and chronic fatigue.

“After a flare-up, women with fibromyalgia find themselves with lagging energy levels because they’ve spent a great deal of [strength] battling the depression and emotional anguish associated with the disease,” Dr. Teitelbaum says.

How can you regain your pep? Natural energy boosters – including exercise, dietary supplements and alternative therapies like meditation and acupuncture – can help.

Here are an expert’s top recommendations to combat fibromyalgia fatigue.

“Making sure you have adequate levels of these nutrients can provide a significant boost in energy,” Dr. Teitelbaum says.

B vitamins: “Food needs to be converted to energy for your body to run,” Dr. Teitelbaum explains. “B vitamins help build energy molecules” – especially after a fibromyalgia flare-up, when fatigue is likely to be at its worst.

Take separate B-vitamin supplements, instead of one “B-complex” capsule, he advises. That way you’ll be sure to get the right amount of each. He recommends 25-50 mg each of B1, B2, B3, B5 and B6, and 500 micrograms (mcg) of B12.

And don’t be alarmed if your urine turns bright yellow. It’s a harmless side effect of the vitamins, he says.

You can also boost the B-vitamin intake in your fibromyalgia diet from food, including fish, poultry, meat, eggs, dairy products and whole grains, as well as leafy green vegetables, beans and peas.

Magnesium: This essential mineral is also key to producing and maintaining your body’s energy stores.

Low levels can disrupt sleep, a problem suffered by 80% of fibromyalgia patients. At the same time, chronic sleep problems can further reduce magnesium levels in cells, according to a 2004 Japanese study.

Magnesium supplements come in capsules, tablets and powders. But you can also get it through food, which means your fibromyalgia diet should include nuts (almonds, cashews and peanuts), seeds, legumes (beans and peas), whole grains and green leafy vegetables such as spinach.

D-Ribose: Supplements of this sugar, which the body produces naturally, are favored by body-builders because it fuels muscle cells, boosting energy.

Fibromyalgia patients who took 5 g three times daily increased their energy levels by 61%, according to a 2008 study conducted by Dr. Teitelbaum and published in the Journal of Alternative and Complementary Medicine.

“Aim for 5 g three times a day for three weeks, and then twice a day after that,” he advises.

Other supplements that help your body’s cells make energy include 200 mg daily of coenzyme Q10, a natural compound and antioxidant, or 1,500 mg daily of acetyl L-carnitine, which is made in muscle and liver tissue and is found in meat, poultry, fish, and some dairy products, Dr. Teitelbaum says.

2. Vitamin D“Vitamin D deficiency is common in fibromyalgia patients because they often avoid sun exposure,” says Pamela Yee, M.D., of the Center for Health and Healing in New York.

The body makes vitamin D from sunlight on the skin – but outdoor activities such as walking, running and gardening often bring on fibromyalgia pain.

“They may be taxing on sore joints,” Dr. Yee explains.

To find out if you’re deficient, see your doctor for a blood test. A normal range is 30.0-74.0 nanograms per milliliter (ng/mL).

If you have a deficiency, your doctor may suggest you take vitamin D supplements and increase your consumption of milk, salmon and other D-rich foods.

Supplements can ease fibromyalgia and chronic fatigue symptoms in patients who have a mild to moderate deficiency, according to a 2009 University of Western Ontario study published in Endocrine Practice.

The latest daily vitamin D recommendations are 600 IU (for women up to 70 years old) and 800 IU (for women over 70), according to the Institute of Medicine, a nonprofit advisory group.

“That can decrease flares and reduce symptoms, including pain and fatigue, of fibromyalgia,” Dr. Teitelbaum says.

Oily fish such as tuna, salmon and sardines are your best food source of omega-3s. Dr. Teitelbaum advises eating a 4-ounce serving, “equal to the size of a personal check,” at least 3-4 times a week for fibromyalgia support.

“When eating canned tuna, choose albacore, because it has three times as much fish oil as chunk light tuna,” he adds.

If you’re concerned about mercury or would rather pop a pill, take a fish oil supplement with more than 600 mg of EPA and DHA per capsule daily, Dr. Teitelbaum advises.

4. AcupunctureThis ancient Chinese healing practice is one of the newest ways of easing chronic fatigue symptoms in fibromyalgia sufferers.

About 40% of patients saw an improvement in fibromyalgia fatigue after completing a 10-week course of acupuncture treatment, according to a 2008 study from the University of Pittsburgh School of Medicine.

Acupuncture “balances the energy that flows through the body and supports its physiological processes, including blood circulation, nervous system operation and immune function,” says Anne Jeffres, a licensed acupuncturist and associate academic dean at Pacific College of Oriental Medicine in New York.

What’s more, it triggers the release of the body’s natural painkillers, she says. That means you spend less energy fighting pain.

And the benefits increase over time, Jeffres says.

“When first treated, a woman might find the effects last only a few hours,” she says. “As treatments continue, her results will generally last longer – for a day or two, then a week or two, and ultimately for months or longer.”

Do each for about five minutes, once or twice a day – “or any time you need a little ‘pick-me-up,’ ” Dr. Yee says.

7. A good night’s sleepYou’d think that because you’re so exhausted, getting enough sleep would be easy. But 80% of fibromyalgia sufferers encounter poor sleep.

That’s because they have a brain-wave pattern typically seen in awake people, according to Harvey Moldofsky, M.D., head of the Sleep Disorders Clinic of the Centers for Sleep and Chronobiology in Toronto.

The pattern, called “alpha intrusions” or “alpha abnormality,” could prevent you from sinking into the deep sleep stages needed to feel refreshed.

The problem starts in the autonomic nervous system, which controls your body’s involuntary processes such as breathing, heart rate and digestion, with help from the sympathetic nervous system (SNS) and the parasympathetic nervous system (PNS).

For fibromyalgia sufferers, the sympathetic nervous system – which helps mobilize the body under stress – “is in overdrive and often stays dominant, even during sleep,” Dr. Teitelbaum says.

To get a good night’s sleep, Dr. Teitelbaum suggests taking a melatonin supplement.

“All it takes is .5 mg,” he says. However, he cautions that most supplements are sold in 3 mg doses, so you should divide the pill into pieces.

How Much Do You Know About Fibromyalgia?Described by Hippocrates in ancient Greece, fibromyalgia is one of the world’s oldest medical mysteries. The disease – a complex illness marked by chronic muscle, tendon and ligament pain, fatigue and multiple tender points on the body – affects about 2% percent of Americans, most of them women. Find out how much do you know about fibromyalgia with this quiz.

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